s of catheter,and extend the service life of a catheter.

AIM: To study the language characteristics and origins of subcortical aphasia. METHODS: One hundred and five patients with unilateral subcortical lesions were confirmed by CT scans. Aphasia examinations, brain electrical activity mapping (BEAM) and CT image standardization were performed at the end of two weeks, one month and two months after onset. RESULTS: Most aphasia patients had lesions in the lateral, front and upper part of basal ganglion. BEAM is largely abnormal in the aphasia patients of lateral type and thalamic aphasia who had serious auditory comprehension disturbance. Prominent dysarthria and dysprosody occurred in aphasia patients with lesions in caudate nucleus. CONCLUSION: Subcortical aphasia has its language characteristics. It is mostly due to the damage of language related zone of hemisphere caused directly or indirectly by subcortical lesions. Thalamus serves as a subcortical center in controlling language and its disturbance causes aphasia in some patients.

ObjectiveTo investigate the clinical efficacy of fire needling plus filiform needles in treating knee osteoarthritis and its effect on the patients’ quality of life.MethodOne hundred and one patients with knee osteoarthritis were randomly allocated to fire needling, filiform needle and combination groups. They were treated with fire needling, filiform needles and fire needling plus filiform needles, respectively. An assessment was made using the WOMAC Osteoarthritis Index and the 36-item Short Form Health Survey (SF-36) in the 101 patients with knee osteoarthritis before and after treatment.ResultFire needling, filiform needles and fire needling plus filiform needles all had a marked therapeutic effect on knee osteoarthritis. The effect of fire needling plus filiform needles was better than those of fire needling and filiform needles (P<0.05,P<0.01). After four weeks of treatment, SF-36 quality of life item sub-scores increased in all the three groups of patients compared with before treatment (P<0.01); SF-36 role physical and general health scores were higher in the combination group than in the fire needling group (P<0.05, P<0.01); SF-36 physical functioning, role physical, general health, social functioning and mental health scores were higher in the combination group than in the filiform needle group (P<0.01).ConclusionFire needling plus filiform needles can effectively treat knee osteoarthritis and improve the patients’ quality of life. Its effects are superior to those of fire needling and filiform needles.

Objective:To evaluate the efficacy and safety of reduced-dose intravitreal ganciclovir for the treatment of acquired immunodeficiency syndrome (AIDS) patients with cytomegalovirus retinitis (CMVR).Methods:A prospective observational cohort study observed 15 AIDS patients (28 eyes) who suffered from CMVR onset between January 2016 and December 2018 at Nanning Aier Eye Hospital. Among this 28 eyes, BCVA of 6 eyes (21.4%) were between moving hand to counting finger, 15 eyes (53.6%) were between 0.02 to 0.1 and 7 eyes were better than 0.1 (25.0%). All eyes received intravitreal injection 0.1 ml of ganciclovir at 4 mg/ml (contain ganciclovir 0.4 mg). The induction regimen was twice weekly for 2 weeks and a maintenance period of the same dose weekly. The mean number of injections was 7.1±1.7 times. For hospitalized patients who had no contraindicated received a 14-day twice daily intravenous ganciclovir (IVG) 5.0 mg/kg·d until complete resolution of CMVR. All patients were divided into intravitreal ganciclovir (IVTG) group and IVTG+IVG group according to different treatment plans, which were 5 cases with 8 eyes and 10 cases with 20 eyes, respectively. The follow-up was more than 6 months. BCVA, complete resolution or stable of the lesion and complications were observed.Results:Six months later, 20 eyes (71.4%) had a obvious reduced or disappeared of the anterior chamber and vitreous inflammation, and the retinal lesions became stable or complete resolution. 24 eyes showed improvements of BCVA and 4 eyes showed stable. 2 eyes (7.1%) presented with BCVA ≤ counting finger, 7 eyes (25.0%) were 0.02- 0.1 and 19 eyes were ≥ 0.1 (67.9%). Compared with before treatment, the ratio of BCVA that less than or equal to counting finger and between 0.02 to 0.1 decreased(21.4% vs 7.1% and 53.6% vs 25.0%, respectively), but the ratio of BCVA better than 0.1 increased (25.0% vs 67.9%). When IVTG+IVG group was compared with IVTG group, the average time-to-resolution of CMVR were 83.2±25.2 and 85.3±24.4 days respectively. There was no significant difference in resolution times( Z=0.17, P=0.87). The ratio of retinal lesions became stable or complete resolution were 75.0% (15 eyes) and 62.5% (5 eyes), there was no evident difference in time-to-resolution between the two groups ( F=0.42, P=0.51). No recurrence was seen during the follow-up period. In cases of unilateral CMVR, there were no patients with a second eye involvement during the follow-up period. No endophthalmitis, vitreous hemorrhage, retinal detachment were found in our study. Conclusion:Reduced-dose intravitreal ganciclovir is a safe and effective treatment option for CMVR.

Objective To explore rationale and clinical application of simplified modified radical thyroideetomy for differentiated thyroid carcinoma.Methods From Jan.2007 to Jun.2010,349 cases of differentiated thyroid carcinoma received simplified operative procedure based on standard modified radical thyroidectomy.The simplified procedure took a low small collar incision(about 10-12 cm).In separating upper and lower skin flaps,subcutaneous tissues covering posterior triangle of neck and posterior edge of sternoeleidomastoid muscle were spared to protect sensory nerves.Subtotal thyroidectomy Was performed to resect the affected lobe,isthmus,and the majority of opposite lobe without considering the size of primary tumor or whether metastasis to the neck lymph nodes happened.Soft tissues of the mainly metastatic areas(Ⅱ a、Ⅲ、Ⅳ、Ⅴb)were cleared.The accessory nerve was not exposed routinely to avoid stimulation.Lymph nodes metastasis in different areas was recorded respectively.Complications in different operative modes were compared.Results Compared with standard modified radical thyroidectomy,the simplified mode had shorter scar-and no limit of neck mobility.Because of muscles and nerves pemervation,movement dysfunction and abnormal sensation of neck and shoulder decreased obviously.The operation duration was shortened.Cervical lymph node status Was evaluated,which provided basis for prognosis judgment and comprehensive treatment.Conclusions The simplified modified radical procedure has the benefit of decreased trauma while maintains the similar recurrence rate compared to modified radical thyroidectomy.It improvs the life quality of patients.This procedure fits the principle of functional radical neck dissection better.

OBJECTIVETo describe a hospital outbreak of severe acute respiratory syndrome (SARS) and summarize its clinical features and therapeutic approaches.

METHODSThe outbreak started with a SARS patient from the community, and a total of 96 people (76 women and 20 men, mean age (29.5 +/- 10.3) years, 93.8% of whom were health care workers) who had exposure to this source patient became infected in a short time. Clinical data in this cohort were collected prospectively as they were identified.

RESULTS(1) The incubation period ranged from 1 to 20 (mean: 5.9 +/- 3.5) days. The duration of hospitalization was (17.2 +/- 8.0) days. (2) The initial temperature was (38.3 +/- 0.6) degrees C, while the highest was (39.2 +/- 0.6) degrees C (P < 0.001), with fever duration of (9.0 +/- 4.2) days. (3) Other most common symptoms included fatigue (93.8%), cough (85.4%), mild sputum production (66.7%), chills (55.2%), headache (39.6%), general malaise (35.4%) and myalgia (21.9%). (4) The radiographic changes were predominantly bilateral in the middle or lower lung zones. The number of affected lung fields was 1.2 +/- 0.8 on presentation, which increased to 2.9 +/- 1.4 after admission (P < 0.001). The interval from the beginning of fever to the onset of abnormal chest radiographs was (3.5 +/- 2.3) days, which increased in size, extent, and severity to the maximum (6.7 +/- 3.5) days later. The time before the lung opacities were basically absorbed was (14.9 +/- 7.8) days. (5) Leukopenia was observed in 67.7% of this cohort. The time between the onset of fever and leukopenia was (4.4 +/- 2.3) days, with the lowest white blood cell count of (2.80 +/- 0.72) x 10(9)/L. (6) The lowest arterial oxygen saturation was (94.8 +/- 3.1)% with supplementary oxygen. (7) Antibiotical therapies included tetracyclines (91.0%), aminoglycosides (83.3%), quinolones (79.2%); 18.8% of the patients received a combination of tetracyclines and aminoglycosides, while 11.5% received a combination of tetracyclines and quinolones, and 63.5% received a combination of tetracyclines, aminoglycosides and quinolones. Vancomycin was used in 13.5% of the patients. (8) 68.8% of the patients were treated with methylprednisolones for a mean interval of (4.9 +/- 2.4) days. The initial dose was (67.3 +/- 28.2) mg/d and the maximal dose was (82.4 +/- 30.5) mg/d. (9) Human gamma-globulin, interferon-alpha, antiviral drugs (oral ribavirin or oseltamivir) were used respectively in 68.6%, 46.9% and 92.7% of the patients. (10) Ninety-five patients (99.0%) had a complete clinical recovery, and only 1 patient (1.0%) died.

CONCLUSIONSSARS appears to be quickly infectious and potentially lethal among health care workers, characterized by acute onset and rapid progression, and mostly bilateral lung involvement on chest radiographs. Proper administration of glucocorticosteroids seems to be of some benefits. Antibiotics, human gamma-globulin, interferon-alpha, and antiviral drugs, although empirically, might be useful to shorten the clinical course.

Adult ; China ; epidemiology ; Cross Infection ; diagnosis ; epidemiology ; therapy ; Disease Outbreaks ; Female ; Humans ; Male ; Severe Acute Respiratory Syndrome ; diagnosis ; epidemiology ; therapy

OBJECTIVETo identify valid measures for preventing outbreaks of severe acute respiratory syndrome (SARS) among protected healthcare workers in isolation units.

METHODSArchitectural factors, admitted SARS cases and infection of healthcare workers in different isolation wards between January 30 and March 30, 2003 were analyzed.

RESULTSFour types of isolation wards were analyzed, including the ward where the thirty-first bed was located on the twelfth floor, the laminar flow ward in the Intensive Care Unit where the tenth bed was located on the fifteenth floor, the ward where the twenty-seventh bed was located on the thirteenth floor of the Lingnan Building, and thirty wards on the fourteenth to eighteenth floors of the Zhongshan Building. The ratios (m(2)/m(3)) of the area of the ventilation windows to the volume of the rooms were 0, 0, 1:95 and 1:40, respectively. Numbers of SARS cases in the wards mentioned above were 1, 1, 1 and 96, respectively. Total times of hospitalization were 43, 168, 110 and 1272 hours, respectively. The infection rates of the healthcare workers in the areas mentioned above were 73.2%, 32.1%, 27.5% and 1.7%, respectively. The difference in the infection rates was of statistical significance.

CONCLUSIONSIsolating SARS cases in wards with good ventilation could reduce the viral load of the ward and might be the key to preventing outbreaks of SARS among healthcare workers along with strict personal protection measures in isolation units.

Adult ; Disease Outbreaks ; prevention & control ; Facility Design and Construction ; Female ; Hospital Units ; Humans ; Infectious Disease Transmission, Patient-to-Professional ; prevention & control ; Male ; Middle Aged ; Patient Isolation ; Severe Acute Respiratory Syndrome ; prevention & control ; Ventilation

OBJECTIVETo explore digestive system manifestations in patients with severe acute respiratory syndrome (SARS).

METHODThe clinical data of 96 cases with SARS admitted into our hospital from February 6, 2003 to March 28, 2003 were retrospectively analyzed.

RESULTSAmong the 96 cases, 26 cases (27%) had diarrhea, 17 (18%) had nausea, 6 (6%) had vomiting, 16 (17%) had bellyache, and 8 (8%) had ALT elevation.

CONCLUSIONSPatients with SARS may have digestive system manifestations; diarrhea is the most common symptom.

Adolescent ; Adult ; Diarrhea ; etiology ; Digestive System Diseases ; etiology ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Severe Acute Respiratory Syndrome ; complications

Objective To investigate the distribution of chronic disease and geriatric syndrome in hospitalized elderly patients with multimorbidity by chronic disease investigation and comprehensive geriatric assessment.Methods A total of 176 patients aged ≥60 years admitted into the geriatric department in our hospital were selected,and demographic factors were collected.Their chronic diseases and geriatric syndrome were recorded.The comprehensive geriatric assessment was consummated,and the biochemical indicators for chronic disease and geriatric syndrome were detected.Results All patients suffered from two or more kinds of chronic diseases.The top three most common diseases were hypertension (112 cases),diabetes (94 cases),and respiratory diseases (73cases).The sum of chronic diseases kinds were ≥3 in 137 patients,≥4 in 78 patients,≥5 in 40 patients.The amount of chronic diseases showed an increased tendency along with ageing.Totally 175 patients had more than one geriatric syndrome,the top three most common types were frailty and prefrailty(133 cases),visual impairment (117 cases),impaired daily activities (107 cases).There were significant differences in the number of geriatric syndrome among different age groups(x2 =16.989,P ＜ 0.001).Spearman analysis showed that the number of patients with geriatric syndrome were positively correlated with age(r =0.307,P＜0.001).Conclusions The prevalence of chronic disease and geriatric syndrome is high in hospitalized elderly patients with multimorbidity,which is increased with aging.We should pay attention to the screening of chronic disease and geriatric syndrome in multimorbid elderly patients

Objective To explore the predictive value of pre-operative comprehensive geriatric assessment(CGA),especially regarding frailty,on the outcomes of fast-track surgery and the risk of post-operative complications after elective laparoscopic surgery in geriatric patients. Methods This prospective study included 75 patients aged 70 years and above undergoing elective laparoscopic surgery from June 2015 to October 2015.CGA was conducted with length of postoperative hospitalization,all-cause mortality and postoperative complications as the endpoints. Results The mean length of hospital stay after surgery was 9.7 day(9.7 ± 7.3)and was correlated with frailty scores(P=0.015)and comorbidities(P= 0.004).Multivariate Logistic regression analysis showed that frailty(OR=5.26,95% CI:1.22-22.55,P=0.025)and comorbidity(OR=5.12,95% CI:1.63-15.99,P=0.005)were predictors of prolonged hospitalization after surgery.Seventeen of 75 patients (22.7%)experienced at least one adverse postoperative outcome,and bivariate analysis showed that adverse events were correlated with poor nutrition(P= 0.012),high frailty scores(P=0.007),and multiple comorbidities(P= 0.005).Furthermore,multiple regression analysis identified malnutrition (OR= 4.30,95% CI:1.03-17.86,P= 0.045),comorbidity(OR= 5.41,95% CI:1.47-19.83,P=0.011)and frailty(OR=6.03,95% CI:1.39-26.10,P=0.016)as predictors of adverse postoperative outcomes. Conclusions Frailty is a risk factor for elderly patients undergone fast-track laparoscopic surgery,and preoperative CGA scores may be used to identify high-risk patients for adverse surgical outcomes and prolonged hospital stay.